The Sexual Century

In The Sexual Century , Ethel Spector Person, a New York psychoanalyst associated with Columbia University, presents a collection of her essays on sexual development and pathology written over the last twenty“five years. Here one finds Dr. Person’s reflections on such topics as cross“dressing, transsexualism, homosexuality, sexual fantasies, and the psychological differences between men and women.

Dr. Person employs all the standard, and now scientifically dubious, Freudian explanatory devices in her arguments, including castration anxiety, the oedipal complex, even penis envy. That, along with the typical Olympian style that Freudians are prone to employ even”or especially”when they are saying nothing different from what others have said before them, deprives this book of much sustaining interest. To make sex boring is difficult, but as many others have noted the Freudians, after a century of practice, have mastered the trick.

Two impressions occurred to me in reading these pages that reflect on the evolution and standing of Freudian thought and practice at the turn of the century. The first is that Dr. Person’s study provides further evidence of the retreat of psychoanalysis from its initial and provocative claims to be the “basic science of human nature.” The second is to notice again the remarkable”but all too human”tendency to claim credit but to avoid blame for actions one has championed. Dr. Person claims credit for her discipline in liberating us from repressive sexual moralism, but takes no responsibility for the deadly consequences of sexual “liberation” that we face today.

This book is devoted to the discussion of sex and its deviations and makes no attempt to employ psychoanalytic views to illuminate other aspects of human psychological constitution or social behavior. Freud and his followers made larger claims for their ideas. They asserted that our libidinous attitudes, drives, and conflicts explained everything”our fears and failures, of course, but also our false claims to rationality, especially as related to our creations, life choices, commitments, and character. Based on these opinions Freud saw himself as a new Copernicus and a “conquistador” from psychology. He preened himself as an authority in the humanities as well as in the clinic, a scientist whose understanding of sex, and of our tendencies to deny and repress its power, gave him the key to understanding human nature and made him a bearer of the cold light of fact to an ignorant and myth“ridden civilization.

No one”especially no scientist of mental life”believes that anymore. The power of reason”and how that power can be a force for good even as it can be disrupted by disease or deflected by conflicts”is evident to all. Our sexual natures are a part of us, but far from the fundamental part. We are both freer and more complex than classical psychoanalysis ever acknowledged.

Not even in the domain of therapy do psychoanalysts reign unchallenged any longer. Cognitive/be­ havioral therapy, specialty group therapies, behavior treatments, and psychopharmacology all have evidence“based authority in the treatments of anxiety, depression, alcohol/drug addiction, and psycho­ ­ ­ social demoralization.

The turn of a psychoanalyst such as Dr. Person towards the rare and esoteric sexual disorders is not an advance into new territory but a surrender of the main concerns of psychiatry to other investigators and clinicians. But even in this clinical cul“de“sac Dr. Person’s conceptual energy is as depleted as her ideas are shopworn.

This is especially disappointing if one seeks answers to practical questions that Dr. Person’s long experience in the sex clinics might deliver. For example, even though their numbers are vanishingly few, a close study of patients with sex“change operations might demonstrate what outcomes constitute a success or failure of this life“threatening operation. Such knowledge would help us decide about its application and utility. Yet Dr. Person apparently does not see this issue as interesting. She describes her experience with these patients by telling psychoanalytically inspired stories about them. But her final opinion”anticipated by any reader accustomed to the fixed rails of Freudian thought”seems at once trivial and untrue: if a patient has long believed that his gender of rearing was in error and really wants this surgical operation, he and/or she best have it. Dr. Person’s distinctions between sex and gender”the one given by nature, the other constructed by culture”are straightforward. But they are the very ideas that lead most of us to recognize that surgical sex“change is nonsense, resting as it does on the preposterous assumption that one’s biologic constitution is as much a malleable artifact as one’s dress.

In three chapters on the correlation between sexual fantasies and sexual experiences, Dr. Person makes her only attempt at an evidence“based opinion. She demonstrates”from questionnaires given to college students”that fantasies and experiences are highly correlated, and concludes from this that the experiences provoke the fantasies. But of course a correlation between observations does not demonstrate causality; the more likely explanation for Dr. Person’s correlative data is that heightened sexual fantasies stimulate the search for sexual experiences. Yet she does not even discuss this possibility.

As one who has watched psychoanalysis evolve in America over the last half of the twentieth century, I find this book a paltry end“product”stuck on sex and making crude errors over cause and correlation. Yet I find it hard to feel pity for Dr. Person: if she is surrendering the broad claims of psychoanalysis and turning essentially to sexology, then she has something else to answer for.

Dr. Person is not alone in claiming that Freudian psychoanalysis was a major force influencing sexual thought and practice in the twentieth century. But the title of her book, The Sexual Century , suggests that Dr. Person believes this influence to be wholly beneficial. She writes, “Sexual liberation has . . . transformed the way [we] regard our bodies and live our sexual lives . . . . These changes in attitudes and behaviors are . . . the product of the ideology of self“fulfillment coupled with medical advances that have made sex safer, less likely to have unwanted consequences.” Even a casual reading of this statement provokes one to wonder how Dr. Person, given that she labors daily in a great American hospital, can ignore the awful results of the liberation she celebrates.

I work in such a place and see it awash with the detritus of sexual liberation. I oversee the treatment of hundreds of patients afflicted with sexually transmitted diseases”many wondering who betrayed them. The HIV virus is a diabolic life form. In the 1970s, when Dr. Person began her writings, no one could have predicted”or even imagined”the bio“characteristics that make it so lethal. But no longer can one offer the excuse of ignorance. The liberationist doctrine certainly helped”along with such other changes in our world as consumerism and ready contraception”to develop the hosts and environments within which the HIV virus flourishes.

The brightest and wealthiest of my HIV“afflicted patients can hold out against its ravages by means of the most complicated of medical/pharmacologic regimens. But most poor patients with HIV are unable to afford or sustain these treatments, and we watch their progressive decline in a fashion one would not wish on anyone”a worsening debilitative weakness, aggressive superimposed infections, dementia, apathy, and death.

In fact, the treatments we presently have (that carry, one should not fail to mention, their own toxic, potentially lethal, side effects) will sooner or later”mostly sooner”fail in their primary purpose as the virus mutates into a resistant form and erupts with new vengeance. I can present many stories about these patients, their impairments, and their fears for the future. Some of them were at one time counterparts of the fantasizing college students Dr. Person studied. But they are now tragic human beings who occasionally will mention to me how they never expected”or were warned about”the medical risks of their sexual behavior. A peculiar kind of blindness is required to work every day in a large American municipal hospital and still laud sexual liberation.

Psychoanalysis was one of the Big Ideas of the twentieth century. This book shows that it may soon join the other leading creeds from that loveless century, Marxism and Eugenics, in the sizable dustbin of history reserved for the doctrines of that time.

Paul R. McHugh, M.D., is the Henry Phipps Professor of Psychiatry and Director and Psychiatrist“in“Chief at the Johns Hopkins Medical Institutions in Baltimore, Maryland.